Desvenlafaxine, paroxetine, venlafaxine, and vortioxetine efficacious and acceptable in stable MDD

JAPAN: According to a study that was published in the Journal, Molecular Psychiatry, the antidepressants desvenlafaxine, paroxetine, venlafaxine, and vortioxetine had reasonable acceptability, effectiveness, and tolerability in the therapy of individuals with stable major depressive disorder.

A significant psychiatric illness with a 12-month prevalence of 4.4% worldwide is major depressive disorder (MDD). People with MDD who are in the acute phase receive pharmacotherapy, such as antidepressant medication, or non-pharmacological treatments, such as electroconvulsive therapy and psychotherapy.

Taro Kishi, MD, PhD, and colleagues asserted, "To the finest of our knowledge, this is the first systematic review and network meta-analysis to examine which antidepressant has the highest ratio of acceptance and effectiveness for the treatment of adult patients with MDD in the maintenance phase,"

The investigators sought to examine the effectiveness, acceptability, tolerability, and safety of antidepressants for the maintenance phase treatment of individuals with major depressive disorder (MDD).

Random-effects model network meta-analysis and a systematic review were carried out for this objective. Only double-blind, randomized, placebo-controlled trials with an enrichment design—in which patients were stabilized on the targeted antidepressant during the open-label study and then randomly assigned to receive the targeted antidepressant or a placebo—were included in this study's search of the PubMed, Cochrane Library, and Embase databases. The results included the 6-month recurrence rate (the key endpoint, effectiveness), cessation for any reason, discontinuation due to adverse events, and the incidence of specific adverse events. Calculated was the risk ratio with a 95% credible interval. The meta-analysis included 34 studies (n = 9384, mean age = 43.80 years, and percentage of females = 68.10%) on 20 antidepressants, including agomelatine, amitriptyline, bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, nefazodone, paroxetine, reboxetine, sertraline, tianeptine, venlafaxine, vilazodone, and vortioxetine) and a placebo.

Key points of the research:

• The 6-month relapse rate was lower with amitriptyline, citalopram, desvenlafaxine, duloxetine, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, reboxetine, sertraline, tianeptine, venlafaxine, and vortioxetine than with placebo.
• In comparison to placebo, desvenlafaxine, paroxetine, sertraline, venlafaxine, and vortioxetine all showed decreased all-cause discontinuation rates.
• Sertraline showed a higher rate of discontinuation due to negative outcomes. Sertraline, vortioxetine, and desvenlafaxine were linked to greater rates of nausea.
• Venlafaxine was tied to a decreased occurrence of lightheadedness.

The authors noted that since medications for an acute depressive episode are frequently prolonged into maintenance, it is important to carefully consider the efficacy, acceptability, tolerability, and safety of treating MDD during this period.

They also came to the conclusion that desvenlafaxine, paroxetine, venlafaxine, and vortioxetine showed significant efficacy and acceptability based on the findings of a network meta-analysis of people with acute MDD.

REFERENCE

Kishi, T., Ikuta, T., Sakuma, K. et al. Antidepressants for the treatment of adults with major depressive disorder in the maintenance phase: a systematic review and network meta-analysis. Mol Psychiatry (2022). https://doi.org/10.1038/s41380-022-01824-z